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Health Reform: The Big Picture Objective

America certainly has a healthcare crisis where costs have spiraled out of control, quality is highly variable, and many do not have access to health insurance. However, the broader, more fundamental crisis, and the one that receives far less attention, is actually a health crisis.

As the debate concerning healthcare reform rages in Washington and across the country, it is easy to lose perspective and to forget that healthcare is not an end in itself but rather one means to an end: better health. The issues currently being debated -- the cost, access, and quality of healthcare, who will pay for care, and how it will be delivered -- are obviously of vital importance, and warrant immediate attention. America certainly has a healthcare crisis where costs have spiraled out of control, quality is highly variable, and many do not have access to health insurance. However, the broader, more fundamental crisis, and the one that receives far less attention, is actually a health crisis.

Swimming against the tide.

Countless breakthroughs in medical practice and technologies have significantly improved the treatment of disease, but these advances have been overshadowed by the faster paced deterioration in the behaviors and lifestyles that cause many of the chronic conditions that account for up to three quarters of all healthcare delivered today. Our healthcare system is actually a disease treatment system.

What we lack is a robust and coordinated system of health promotion that effectively influences environments, social norms, and major institutions, and educates and empowers individuals in order to choose lifestyles and behaviors that allow them to get and stay well. Such a system, founded on a wellness orientation, would dramatically improve quality of life for millions of Americans while reducing the risk of many chronic conditions, and demand on our healthcare system. There are many individuals and institutions out there right now championing the wellness message, but our health awareness has largely been hijacked by healthcare defined as disease treatment, leaving health promotion drastically under-appreciated.

Epidemic of preventable disease.

We put an increasing amount of our resources into disease treatment while largely ignoring the fact that many of these diseases are predominantly preventable. Basic lifestyle behaviors including healthful diet, regular physical activity, no smoking, moderate alcohol intake, and maintaining a healthy weight could prevent 80% of heart disease and type II diabetes, 90% of obesity, and 40% of cancers. In addition, a healthier lifestyle would allow those diagnosed with disease to experience a higher quality of life every day.

Our bodies have been programmed by evolution for a different environment as the old Chiffon margarine commercial warned "It's not nice to fool with Mother Nature!" If we are to reverse current trends in chronic disease and to achieve our physical and mental potential, we need to return to a more evolutionarily and physiologically sound lifestyle. No politician wants to say this but I do not know of a public health expert who would disagree. Our healthcare system as it stands is ill-equipped to champion this re-evolution. Doctors are specialists in the diagnosis and treatment of disease. What we need are for those who are specialists at the promotion of health and wellness to step forward to lead a wellness movement not to replace our healthcare system, but to step into its proper place as a positive counterbalance to it. This would alleviate human disease and suffering, as well as the undue burden on our healthcare system.

All hands on deck.

The good news is that we already know the solution. The bad news has two parts; first, getting anybody to make a fundamental behavior change is never easy and second, the healthcare system has no incentive to help. Ultimately this will require a big shift in our thinking, and substantive changes to our environment, our social norms, and the way in what we pay for from the healthcare system. In the short term we can, at least, start by empowering individuals with the knowledge and tools that they need to make good health decisions and to take action to improve their health; to enable each person to become an active and responsible champion of their own wellbeing. This can encourage people to improve their health behaviors, and fundamentally shift the ways in which they engage with the healthcare system - more informed healthcare consumers are more active partners with their providers, take greater responsibility for their care and recovery, and are more discerning about the quality and cost of their care.

Addressing the healthcare crisis is essential, but the root causes of our health crisis run much deeper. There are many ways to make a difference but they all have the same starting point - get everyone involved.